title: Cardiac device complications in the cognitively impaired.
abstract: BACKGROUND
  Patients with preexisting mild cognitive impairment or dementia may be at increased risk for developing cardiac device complications due to an impaired ability to follow postimplant care instructions. We sought to determine whether rates of infection, lead dislodgement, or appropriate or inappropriate implantable cardioverter defibrillator (ICD) shocks are increased in this population.
  
  
  METHODS
  Medical charts of 561 patients with mild cognitive impairment or dementia who underwent pacemaker (PM) or ICD implantation between January 2002 and October 2009 at Mayo Clinic were identified. A total of 134 patients who were diagnosed with cognitive impairment or dementia before device implantation or within 1 year of implantation were compared with 134 matched controls. Information was collected on patient characteristics, comorbid medical conditions, ejection fraction, complications, device type, device therapy, and mortality. Device information was prospectively entered into a database and retrospectively reviewed.
  
  
  RESULTS
  Of the 134 patients with mild cognitive impairment and dementia, 99 underwent PM implantation and 35 underwent ICD implantation. Compared to controls, there was no difference in patient characteristics, ejection fraction, or comorbidities except for diabetes, which was more prevalent in the cognitively impaired and demented group (18.7% vs 30.6%, P = 0.02). There was no difference in device therapy and complications (14.4% vs 5.8%, P = 0.268). However, there was a decreased survival in patients with cognitive impairment and dementia when compared to the control group (42% vs 67% at 5 years, P = 0.007).
  
  
  CONCLUSIONS
  Patients with cognitive impairment and standard device indications are not at increased risk for device complications and therapy but their survival is much lower than in matched controls. The cause of this lower survival is unknown but may be related to the underlying neurological disease. Presence of cognitive impairment should therefore be considered when contemplating implantation of a cardiac device.
authors.affiliation: Division of Cardiovascular Disease.
authors.forename: Abdi
authors.initials: A
authors.lastname: Jama
authors.forename: Alejandro
authors.initials: A
authors.lastname: Rabinstein
authors.forename: David
authors.initials: D
authors.lastname: Hodge
authors.forename: Regina
authors.initials: R
authors.lastname: Herges
authors.forename: Samuel
authors.initials: S
authors.lastname: Asirvatham
authors.forename: Yong-Mei
authors.initials: YM
authors.lastname: Cha
authors.forename: Brian
authors.initials: B
authors.lastname: Powell
authors.forename: Robert F
authors.initials: RF
authors.lastname: Rea
authors.forename: Paul
authors.initials: P
authors.lastname: Friedman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015984:Causality; D003072:Cognition Disorders / Q000401:mortality* / Q000523:psychology / Q000534:rehabilitation; D015897:Comorbidity; D017147:Defibrillators, Implantable / Q000523:psychology / Q000706:statistics & numerical data*; D003704:Dementia / Q000401:mortality* / Q000523:psychology / Q000534:rehabilitation; D004556:Electric Injuries / Q000401:mortality* / Q000523:psychology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D010138:Pacemaker, Artificial / Q000523:psychology / Q000706:statistics & numerical data*; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000401:mortality* / Q000523:psychology; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate
keywords: ICD; cognitive impairment; complications; dementia; pacemaker